Study objectives: Myocardial infarction with
angiographically normal coronary arteries (MINC) is a life-threatening
event with many open questions for physicians and patients.
There are little data concerning the prognosis for patients with
Design: Retrospective follow-up study.
Setting: Tertiary referral center.
Patients: Patients with MINC were investigated and compared
to age- and sex-matched control subjects with myocardial infarction due
to coronary artery disease (CAD). The patients were examined clinically
using stress exercise and hyperventilation tests. Migraine and
Raynaud’s symptoms were determined by means of a standardized
questionnaire. Serum lipoproteins; the seroprevalence of
cytomegalovirus, Helicobacter pylori, and
Chlamydia pneumoniae infections; and the most frequent
causes of thrombophilia were assessed.
and results: From > 4,300 angiographies that were performed
between 1989 and 1996, 21 patients with MINC were identified. The mean±
SD patient age at the time of myocardial infarction was 42 ± 7.5
years. When compared to control subjects (n = 21), patients with MINC
had fewer risk factors for CAD. In contrast, MINC patients had more
frequent febrile reactions prior to myocardial infarction (six patients
vs zero patients; p < 0.05), and the migraine score was
significantly higher (7.1 ± 6.3 vs 2.2 ± 4.1; p < 0.01). The
seroprevalence of antibodies against cytomegalovirus, C
pneumoniae, and H pylori tended to be higher in
patients with MINC and CAD as compared to matched healthy control
subjects. Three patients with MINC vs none with CAD had coagulopathy.
During follow-up (53 ± 37 months), no major cardiac event occurred
in the MINC group; no patients with MINC vs nine with CAD
(p = 0.0001) underwent repeated angiography.
Conclusion: High migraine score and prior febrile infection
together with a lower cardiovascular risk profile are compatible with
an inflammatory and a vasomotor component in the pathophysiology of the
acute coronary event in MINC patients. The prognosis for these patients